Clinical outcomes of patients with coronary artery aneurysm after the first generation drug-eluting stent implantation

Objectives: We sought to investigate the long-term clinical outcomes of patients with coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation, compared with patients without CAA. Background: CAA developed after DES implantation is a rare but associated with poor clinical outcome. Methods: We retrospectively compared 78 patients with CAA after DES implantation with 269 patients without CAA who underwent DES implantation for complex lesions (controls). The primary endpoint was defined as major adverse cardiac events (MACE), the composite of all-cause death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR). Results: Morphologically, CAAs were saccular (32%), fusiform (13%), or microform (55%). The stent types involved were Cypher (n=56, 71.8%) and Taxus (n=22, 28.2%). During a median follow-up period of 1164 days, the incidence of MACE was significantly higher in the CAA group (26.9 vs. 2.2%, P<0.001); the difference was driven mainly by nonfatal MI (11.5 vs. 0%, P<0.001) and TLR (20.5 vs. 1.9%, P<0.001). The incidence of stent thrombosis was higher in the CAA group (12.8 vs. 0.74%, P<0.001), irrespective of the maintenance of dual antiplatelet therapy. In the CAA group, Cox regression analysis showed significantly higher hazard ratios of CAA for MACE during the follow-up period. Further analyses after propensity-score matching of 65 pairs also showed similar results. Conclusions: The incidence of MACE was higher in patients with CAA compared with patients without CAA after DES implantation. This difference was driven by TLR and nonfatal MI and widened over time.